Screm Gianluca, Mondini Lucrezia, Confalonieri Paola, Salton Francesco, Trotta Liliana, Barbieri Mariangela, Mari Marco, Reccardini Nicolò, Della Porta Rossana, Kodric Metka, Bandini Giulia, Hughes Michael, Bellan Mattia, Lerda Selene, Confalonieri Marco, Ruaro Barbara
Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy.
Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi (AOUC), 50134 Florence, Italy.
Diagnostics (Basel). 2024 Jan 24;14(3):254. doi: 10.3390/diagnostics14030254.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA), all of which are characterised by inflammation of small-medium-sized vessels. Progressive understanding of these diseases has allowed researchers and clinicians to start discussing nailfold video capillaroscopy (NVC) as a future tool for many applications in daily practice. Today, NVC plays a well-established and validated role in differentiating primary from secondary Raynaud's phenomenon correlated with scleroderma. Nevertheless, there has not been sufficient attention paid to its real potential in the ANCA-associated vasculitis. In fact, the role of NVC in vasculitis has never been defined and studied in a multicentre and multinational study. In this review, we carried out a literature analysis to identify and synthesise the possible role of capillaroscopy for patients with ANCA-associated vasculitis.
Critical research was performed in the electronic archive (PUBMED, UpToDate, Google Scholar, ResearchGate), supplemented with manual research. We searched in these databases for articles published until November 2023. The following search words were searched in the databases in all possible combinations: capillaroscopy, video capillaroscopy, nailfold-video capillaroscopy, ANCA-associated vasculitis, vasculitis, granulomatosis with polyangiitis, EGPA, and microscopic polyangiitis.
The search identified 102 unique search results. After the evaluation, eight articles were selected for further study. The literature reported that capillaroscopy investigations documented non-specific abnormalities in 70-80% of AAV patients. Several patients showed neoangiogenesis, capillary loss, microhaemorrhages, and bushy and enlarged capillaries as the most frequent findings. Furthermore, the difference between active phase and non-active phase in AAV patients was clearly discernible. The non-active phase showed similar rates of capillaroscopy alterations compared to the healthy subjects, but the active phase had higher rates in almost all common abnormalities instead.
Microvascular nailfold changes, observed in patients affected by vasculitis, may correlate with the outcome of these patients. However, these non-specific abnormalities may help in the diagnosis of vasculitis. As such, new analysis analyses are necessary to confirm our results.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）包括肉芽肿性多血管炎（GPA）、显微镜下多血管炎（MPA）和嗜酸性肉芽肿性多血管炎（EGPA），所有这些疾病的特征都是中小血管炎症。对这些疾病的逐步了解使研究人员和临床医生开始讨论甲襞视频毛细血管镜检查（NVC），将其作为未来日常实践中许多应用的工具。如今，NVC在区分原发性雷诺现象与硬皮病相关的继发性雷诺现象方面发挥着既定且经过验证的作用。然而，其在ANCA相关血管炎中的真正潜力尚未得到足够的关注。事实上，NVC在血管炎中的作用从未在多中心、跨国研究中得到定义和研究。在本综述中，我们进行了文献分析，以确定并综合毛细血管镜检查对ANCA相关血管炎患者可能发挥的作用。
在电子档案库（PUBMED、UpToDate、谷歌学术、ResearchGate）中进行批判性研究，并辅以手工检索。我们在这些数据库中搜索截至2023年11月发表的文章。在数据库中以所有可能的组合搜索以下关键词：毛细血管镜检查、视频毛细血管镜检查、甲襞视频毛细血管镜检查、ANCA相关血管炎、血管炎、肉芽肿性多血管炎、EGPA和显微镜下多血管炎。
搜索共识别出102个独特的搜索结果。经过评估，选择了8篇文章进行进一步研究。文献报道，毛细血管镜检查发现7%至8%的AAV患者存在非特异性异常。几名患者表现出新生血管形成、毛细血管缺失、微出血以及最常见的毛细血管丛生和扩张。此外，AAV患者活动期和非活动期之间的差异清晰可辨。与健康受试者相比，非活动期毛细血管镜检查改变的发生率相似，但活动期几乎所有常见异常的发生率更高。
血管炎患者观察到的甲襞微血管变化可能与这些患者的预后相关。然而，这些非特异性异常可能有助于血管炎的诊断。因此，需要新的分析来证实我们的结果。
